2011-03-01_PR_Packet - Laserfiche WebLink

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Ct Ct 1C th Ci Ct C) C73 r-4 011N th 1C -cs Ct Ct bb bb Ct VC One Form Per Participant Please Print Name (last name first) Age Sex: M F Address -------------------------- City----------____-- State --Zip er b m u N (h) ___-- Telephone p - - ------------ Birth Date -- -- ---- Event: o 5K Run o 10K Run ci Wheelchair 11 Fun Run Please make Run registration check payable to:Rfinjor the Roses 10K Roll Rec/Fitness 11 10K Roll Pro/Racer Please make Roll registration check payable to:Rolljor the Roses T-Shirt Size: Youth Med Youth L Adult S Adult Med Adult L Adult XL Adult XXL ChampionChip® Number * If Participant has one, Roll for the Roses Participants only--—— Waiver:Knowingly and at my own risk,I hereby apply to enter an athletic contest,and do hereby waive and release any and all claims for damages that I may incur as a direct or indirect result of my participation in this event against the sponsors,coordinating groups,and any individuals associated with the event for said injuries.I verify that I have full knowledge of the event and that I am physically fit and sufficiently trained to participate. Each form must be signed. I have read and agree to the above waiver: Signature Parent of Guardian (if under 18) Tennessen Warning:The information requested on registration form will be used to verify eligibility and determine staff,faculty and equipment needs.Your/your child's name,age,address,telephone number and health information will be provided to city staff,volunteers,the city manager,insurer and auditor.Although you are not legally required to disclose this information,failure to do so will prevent you/your child from participating.